2型糖尿病患者心肺耐力及其临床危险因素

Cardiopulmonary endurance and its clinical risk factors in patients with type 2 diabetes mellitus

目的探讨2型糖尿病(T2DM)患者心肺耐力及其临床危险因素。方法选取2020年1月1日至2021年4月30日就诊于天津市第三中心医院内分泌科的47例健康对照者(对照组)及129例T2DM患者(T2DM组)为研究对象,比较T2DM患者与健康对照者的静态肺功能观测指标及心肺运动试验(CPET)观测指标。以峰值摄氧量(VO_(2)peak)是否降低为标准将T2DM组患者分为正常组(n=47)和降低组(n=82),采用logistic回归分析T2DM患者VO_(2)peak降低的临床危险因素。结果与对照组相比,T2DM患者VO_(2)peak、峰值摄氧量占预计值的百分比(VO_(2)peak%pred)、代谢当量、无氧阈(AT)、峰值氧脉、△摄氧量/△功率(△VO_(2)/△Work)、潮气末二氧化碳分压(PetCO_(2))均明显降低,差异有统计学意义(P<0.05)。与对照组相比,T2DM患者峰值运动时的无效腔/肺通气(V_(D)/V_(T) peak)、二氧化碳当量(VE/VCO_(2))明显升高,差异有统计学意义(P<0.05)。单因素分析结果提示,BMI、糖化血红蛋白水平、吸烟史及谷丙转氨酶(ALT)水平是影响T2DM患者VO_(2)peak降低的危险因素(P<0.05)。多因素logistic回归结果提示,BMI≥24、吸烟史、糖化血红蛋白水平、ALT水平是T2DM患者VO_(2)peak降低的独立危险因素(P<0.05)。结论T2DM患者的心肺耐力明显降低,BMI≥24、吸烟史、糖化血红蛋白水平、ALT水平是T2DM患者心肺耐力降低的独立危险因素。

Objective To explore cardiopulmonary endurance and its clinical risk factors in patients with type 2 diabetes mellitus(T2DM).Methods A total of 47 healthy control subjects(Control group)and 129 T2DM patients(T2DM group)who were admitted to the Department of Endocrinology,Tianjin Third Central Hospital from January 1,2020,to April 30,2021,were selected as research objects.The observation indexes of static pulmonary function and cardiopulmonary exercise test(CPET)were compared between T2DM patients and healthy control subjects.Patients with T2DM were divided into the normal group(n=47)and the decrease group(n=82)according to whether the peak oxygen uptake(VO_(2) peak)decreased or not.Logistic regression was used to analyze the clinical risk factors of decreases in VO_(2) peak in T2DM patients.Results Compared with the control group,VO_(2) peak,VO_(2) peak%pred,metabolic equivalent,anaerobic threshold(AT),peak oxygen pulse,△VO_(2)/△Work and partial pressure of end-tidal carbon dioxide(PetCO_(2))in T2DM patients were significantly reduced,with statistically significant differences(P<0.05).Compared with the control group,the ineffective chamber/lung ventilation(V_(D)/VTpeak)and carbon dioxide equivalent(VE/VCO_(2))of T2DM patients during peak exercise were significantly higher,with statistically significant differences(P<0.05).The results of the univariate analysis showed that BMI,glycosylated hemoglobin level,smoking history,and alanine transaminase(ALT)level were the risk factors for lowering VO_(2) peak in T2DM patients(P<0.05).Multivariate logistic regression results showed that BMI≥24,smoking history,glycosylated hemoglobin level,and ALT level were independent risk factors for the decrease of cardiopulmonary endurance in T2DM patients(P<0.05).Conclusion Cardiopulmonary endurance of T2DM patients significantly reduces.BMI≥24,smoking history,glycosylated hemoglobin level,and ALT level are independent risk factors for the reduction of cardiopulmonary endurance of T2DM patients.